L. Cindy Chang

The unique culture and languages of Indigenous Mexican immigrants to the United States, a substantial portion of the nation’s agricultural workforce, has limited participation of this population in tobacco and other health related research. Our established community-academic team [Mixteco Indigena Community Organizing Project (MICOP) and UCLA] developed and conducted a community survey ( n = 200) from February – October 2024, in Spanish ( n = 145), English ( n = 10) or Mixteco ( n = 45), aimed to understand tobacco use and knowledge among adults in this population. Participants (mean age 26 years; 71% married; 48% female; 43% ≤ elementary education) reported considerable tobacco use and second-hand exposure. Results illustrate gaps in knowledge regarding tobacco’s health harms and limited experience with tobacco prevention or control programming. Our findings suggest that prevention programs may provide greatest benefits for recent immigrants who rely exclusively on their native Indigenous language, and that cessation resources may be most needed by community members who have been in the US longer, have some Spanish proficiency and greater exposure to industry marketing. This work adds to the limited literature regarding this marginalized population’s health needs and will serve as a guide for our ongoing community-academic efforts to develop, implement, evaluate and disseminate culturally and linguistically tailored tobacco prevention and control programming for the Indigenous Mexican agricultural worker community in California and beyond.

Churches are an important asset and a trusted resource in the African American community. We needed a better understanding of their readiness to engage in health promotion before launching a large-scale health promotion effort in partnership with South Los Angeles churches. In 2017, we conducted surveys with leaders of 100 churches. Surveys were conducted face-to-face (32%) or by telephone (68%) with senior pastors (one per church) and lasted on average 48 min. We compared small (less than 50 active members), medium (50–99 active members) and large churches (at least 100 active members), and assessed which church characteristics were associated with the implementation of wellness activities. Medium and large churches conducted significantly more wellness activities than small churches and were more likely to have wellness champions and health policies. Regardless of church size, insufficient budget was the most commonly cited barrier to implement wellness activities (85%). A substantial proportion of churches was not sure how to implement wellness activities (61%) and lacked volunteers (58%). Forty-five percent of the variation in the number of wellness activities in the last 12 months was explained by church characteristics, such as size of congregation, number of paid staff, leadership engagement, having a wellness ministry and barriers. Many churches in South Los Angeles are actively engaged in health promotion activities, despite a general lack of resources. We recommend a comprehensive assessment of church characteristics in intervention studies to enable the use of strategies (e.g., stratification by size) that reduce imbalances that could mask or magnify study outcomes. Our data provide empirical support for the inner settings construct of the Consolidated Framework for Implementation Research in the context of health promotion in African American churches.

The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N= 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect =0.166, SE= 0.07, p<.05; direct effect=0.296, SE= 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population.